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Bloodborne Pathogen Exposures

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WEAR GLOVES when dealing with wounds, drawing blood, assisting with surgical ... Therefore, there is no benefit to post-exposure administration of gamma globulin. ... – PowerPoint PPT presentation

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Title: Bloodborne Pathogen Exposures


1
Bloodborne Pathogen Exposures
  • Usually refers to contact with body fluids or
    tissues known or suspected to be from an
    individual with HIV, hepatitis B or C.
  • Includes needlesticks, exposure of fluid/blood to
    broken (or intact) skin and splashes to eye or
    mouth.

2
Basic ID Stuff
  • WEAR GLOVES when dealing with wounds, drawing
    blood, assisting with surgical procedures, etc.
    Additional protection e.g. gowns, goggles or
    faceshields may be needed as determined by the
    circumstances
  • WASH affected body part thoroughly and promptly
    when body fluid exposure may have occurred.
  • Be vaccinated against hepatitis B.

3
What Not to Worry About
  • Important to know which fluids are NOT
    contagious. Tears, feces, sweat, nasal
    secretions, urine, sputum, saliva and vomitus are
    not considered infectious unless visibly bloody.
    A gray area exists for amniotic, pleural,
    synovial and pericardial fluids and for CSF.
    Consider them to be infectious.

4
What to Worry About
  • Truly infectious body fluids include blood,
    semen, vaginal fluid or other fluids contaminated
    with visible blood.
  • Human bites raise the dilemma of both individuals
    being exposed to each others fluids.

5
EVALUATION
  • Careful inspection of the injured body part
    should allow determination of whether skin is
    intact or not (chapped, abraded or affected by
    dermatitis).
  • Medical history is obtained from the source
    patient (if known) regarding prior infectious
    diagnoses or high risk behavior.

6
Testing
  • The source patient should be tested for
    antibodies to HIV, HCV and Hepatitis B surface
    antigen (HBsAg).
  • The exposed individual should be tested for
    antibodies to HIV, HCV and HBV. If previously
    vaccinated against HBV, antibody to surface
    antigen (HBsAb) would indicate immunity.

7
Hepatitis B Exposure
  • Management varies depending on the vaccination
    history and immune status of the exposed HCW and
    the status of the source.
  • Summary Table will be distributed

8
Hepatitis C Exposure
  • Hepatitis C-if source patient tests positive for
    HCV, exposed HCW should have LFTs and HCV RNA
    measured by PCR at 6 weeks. A repeat HCV antibody
    should then be done at 4-6 months. Individuals
    who have a positive early HCV PCR may require
    additional testing and may be offered interferon
    therapy after appropriate consultation.

9
Hepatitis C Exposure
  • As HCV positive individuals are excluded from the
    blood donor pool, currently available
    preparations of IVIG contain no anti-HCV
    antibodies. Therefore, there is no benefit to
    post-exposure administration of gamma globulin.

10
HIV
  • Actual risk of transmission following a
    percutaneous exposure is around 0.3 (3 in 1000)
    and, after mucous membrane exposure, around
    0.09.
  • Many factors influence these numbersdeep
    puncture vs. superficial injury, hollow
    (venipuncture) vs. non-hollow (suture) needle,
    level of source HIV viremia, etc.

11
Post-Exposure Prophylaxis (PEP)
  • Because of the proven efficacy of Zidovudine
    (AZT) in reducing vertical transmission of HIV,
    PEP is recommended in situations when potential
    exposure may have occurred.
  • It should be implemented within hours of
    exposure. As a practical matter, this is usually
    before source testing is complete.

12
HIV PEP
  • There are a number of variables to consider when
    deciding on whether a two- or three-drug
    combination is to be used. In addition, a number
    of different drug regimens are available.
  • You may wish to consult with an infectious
    disease or HIV specialist for advice.

13
HIV PEP
  • As PEP is usually started before HIV results from
    the source patient are known, you should initiate
    therapy and then re-evaluate the patient when
    testing is complete. If source patient is
    negative, PEP can be stopped. If source turns out
    to be HIV infected, 4 weeks of combination
    therapy is given.
  • These drugs have some significant toxicities and
    close monitoring is necessary.

14
HIV PEP
  • Although we must offer PEP to exposed HCWs, we
    cannot force them to start the medication
    regimen, nor can we force them to complete it.
    Women must also agree to avoid pregnancy during
    this period as some drugs (e.g. Efavirenz) are
    teratogenic. We have female HCWs sign a voluntary
    agreement to avoid pregnancy and get a signed
    declination if the HCW refuses PEP.
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